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Registrant #1

If you have registered this person for another race, click “Previous Participant” instead of filling out the user information.

Previous Participant

Date of Birth:Phone:Gender:

Update User InformationThe information for this user will be changed as shown in the form below.

Basic Info

Who are you registering? *I am at least 18 years old and registering myself.I am at least 18 years old and registering someone else 18 or older.I am at least 18 years old and registering someone under 18 years old as their parent or guardian.

By selecting this box, you are indicating that you are the parent/guardian of the person you are about to register. Additionally, if the child is under the age of 13, you are consenting to the collection and use of the information about the child for the purpose of the registration as described in our privacy policy.

Parent/Guardian First Name *

Parent/Guardian Last Name *

First Name *

Last Name *

E-mail *

Confirm E-mail *

Password

Password *

To be able to access / edit your registration.

Confirm Password *

Address

Street Address *

Country *

Zip Code *

City *

State *

Additional Information

Date of Birth *

Format: mm/dd/yyyy

Used for age group calculations

Gender *MaleFemale

Phone *

Format: ###-###-####

Choose Your Event(s) *

AppleChase 5K SPA 23 Run For Life

$30.00 + $3.00 SignUp Fee ?

— Nada Pricing May Apply(Group Pricing)

(No Nada Selected)

Nada

Apple Chase 12K SPA 23 Run For Life

$30.00 + $3.25 SignUp Fee ?

— Nada Pricing May Apply(Group Pricing)

(No Nada Selected)

Nada

Chaser of Apples (Volunteer)

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Waiver

In consideration of your accepting this entry, I, the undersigned, intending to be legally bound for myself, heirs, executors, and administrators, waive and release any and all claims for damages and injury I may have against Chilton Medical Center, Chilton Medical Center Foundation, the Township of Pequannock, Pequannock Township High School, PCRC, Main Street Marketing & Events, Tristate Timing, USATF, RunSignup.com their agents, servants, successors, and all other persons or entities involved in the promotion or staging of the Apple Chase Run for Life: 12K Run and 5K Run/Walk. I also give my permission for the use, without fee, of my name and picture in any broadcast, telecast, or print media account of this event for promotional and publicity purposes. I attest and verify that I am physically fit and have trained sufficiently for this event to be held on Sunday, Oct 15, 2017, in the Township of Pequannock, NJ. I accept responsibility for the return of the rental timing chip.

I certify as a material condition to my being permitted to enter this race that I am physically fit and sufficiently trained for the completion of this event and that my physical condition has been verified by a licensed Medical Doctor. By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to the above waiver.

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By checking this box, I agree to the waiver and that I am 18 or older, or that I have the authority to register these participants and agree to the waiver for them, and agree to the Privacy Policy.

This is a service fee for processing your race application.

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Nada Details

Nada Name:Nada Administrators:Gender:Minimum Age:Maximum Age:

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Nada Type *

Nada Type *

Nada Type *

Chilton Medical Center Foundation

Nada Name *

Password *

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You have selected to edit the information for .
By doing so, information for other races or events you have registered for may be updated as well.
You should only use this option to update information about , such as a typo in their name or an address change.
If you are trying to register someone else like a spouse, child, or friend, you should NOT use this option.